A Comparison of Efficacy of Three Techniques of Conization : Cold Knife , Laser , and LEEP

Jung, Y D; Jung, S K; Park, J W; Kim, H S; Lee, E Y; Kim, Y M; Lee, K W

Abstract

The treatment of cervical intraepithelial neoplasia ranges from total hysterectomy to local destructive methods. The need for conservative treatment has increased as more lesions are being detected in young women who have not completed their family. Laser conization has been used to manage CIN since 1976. The use of loop diathermy was first described in 1981. This study was designed to compare the treatment reliability, efficacy, and safety of laser and cold knife conization and LEEP. From January 1992 to December 1995, 74 patients were enrolled. They were all cervical intraepithelial neoplasia. They were performed three techniques of conization: Cold Kinfe, Laser, and LEEP. The results were as follows: 1. All 74 patients were examined: 13 Cold Knife cases, 37 Laser cases, and 24 LEEP cases. 2. The mean age was 40.2 years (range 18~70 years). 3. Mean operation time was less in the LEEP group (p=0.0001). 4. During the pathological review of the conization, there were no differences in the three groups (p=0.585). 5. The major problem was difficulty in evaluating the lesion and its margins due to the coagulation induced by the laser or the LEEP: 4 cases (laser group) and 4 cases (LEEP group). 6. During postoperative follow-up, the number of abnormal Pap smear (2 cases)was the same in the three groups (p=0.585). These results suggest that LEEP is quicker, safer, and lower cost than laser and cold knife conization for the management of cervical intraepithelial neoplasia. The assessment of the margins is better with the cold knife conization than with the laser or the LEEP.